Provider Demographics
NPI:1922217280
Name:DIBELLO, BROOKE JASMINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:JASMINE
Last Name:DIBELLO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 E FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-5423
Mailing Address - Country:US
Mailing Address - Phone:217-344-9290
Mailing Address - Fax:
Practice Address - Street 1:1713 E FAIRLAWN DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-5423
Practice Address - Country:US
Practice Address - Phone:217-344-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional